THE EFFECT OF CELIAC DISEASE ON PREGNANCY OUTCOME

Yıl 2022, Cilt: 29 Sayı: 3, 292 - 298, 30.09.2022

Ayşe Keleş Gulsah Dagdeviren Ozge Yucel Celik Gül Özgen Cantekin İskender Şevki Çelen

https://doi.org/10.17343/sdutfd.1056129

Öz

Objective
To investigate the association between celiac
disease (CD), defined as gluten-induced autoimmune
enteropathy in genetically susceptible individuals, and
adverse pregnancy and neonatal outcomes and to
investigate the effects of a gluten-free diet on these
outcomes.
Material and Method
This retrospective study was conducted between
pregnant women with CD, who delivered in our
hospital between 2017-2022, and healthy pregnant
women who delivered during the same period.
Patient demographic characteristics, pregnancy
complications, gestational age at delivery, birth weight,
and neonatal intensive care needs were analyzed.
Results
During the study period, 30 pregnant women with
CD were identified. The control group was formed
by 90 healthy pregnant women. Maternal age was
higher in pregnant women with CD (p=0.020). There
was no difference between groups in gravidity, parity,
abortion, and fertility treatment. Multiple pregnancies
and placenta previa occurred more frequently in
the CD group (p=0.034 and p=0.003, respectively).
Preterm births were significantly more common in
the CD group (p=0.000). There were no differences
between groups in other pregnancy complications.
The gluten-free diet improved pregnancy and neonatal
outcomes in the CD group. However, the increase in
preterm birth rate remained compared to the control
group (p=0.006).
Conclusion
CD is associated with preterm birth in pregnancy and
adverse neonatal outcomes. Although a gluten-free
diet reduces adverse outcomes, the presence of CD
continues to pose a risk for preterm birth.

Anahtar Kelimeler

Adverse outcome, celiac disease, pregnancy

ÇÖLYAK HASTALIĞININ GEBELİK SONUÇLARI ÜZERİNDEKİ ETKİSİ

Öz

Amaç
Genetik olarak yatkın kişilerde glutene bağlı otoimmun
enteropati olarak tanımlanan Çölyak Hastalığının (ÇH)
olumsuz gebelik ve yenidoğan sonuçları ile ilişkisini
araştırmak ve glütensiz beslenmenin bu sonuçlar üzerindeki
etkisini incelemektir.
Gereç ve Yöntem
Retrospektif olarak tasarlanan bu çalışma, 2017-2022
yılları arasında hastanemizde doğum yapan ÇH olan
gebeler ile aynı dönemde doğum yapan sağlıklı gebeler
arasında gerçekleştirildi. Hastaların demografik verileri,
gebelik komplikasyonları, doğum haftası, doğum
kilosu ve yenidoğan yoğun bakım ihtiyacı analiz edildi.
Bulgular
Çalışma süresince 30 ÇH olan gebe tespit edildi. Kontrol
grubu 90 sağlıklı gebeden oluşturuldu. ÇH olan gebelerde
maternal yaş daha yüksekti (p= 0,020). Gravide,
parite, abortus ve fertilite tedavisi açısından gruplar
arsında farklılık saptanmadı. ÇH grubunda çoğul gebelik
ve plasenta previa olguları fazla görüldü (p=0,034
ve p=0,003). Erken doğum ÇH grubunda anlamlı derecede
fazla bulundu (p=0,000). Diğer gebelik komplikasyonları
açısından fark saptanmadı. Glutensiz beslenme,
ÇH varlığında gebelik ve yenidoğan sonuçlarını
iyileştirmekle birlikte erken doğum kontrol grubundan
hala fazla tespit edildi (p=0,006).
Sonuç
ÇH, gebelikte erken doğum ve olumsuz yenidoğan
sonuçları ile ilişkilidir. Glutensiz beslenme olumsuz sonuçlarda
azalma yapmakla birlikte ÇH’nın varlığı erken
doğum açısından risk teşkil etmektedir.

Anahtar Kelimeler

Çölyak hastalığı, gebelik, olumsuz sonuç

Kaynakça

• 1. Fasano A, Catassi C. Celiac disease. New England Journal of Medicine. 2012;367(25):2419-26.
• 2. Mustalahti K, Catassi C, Reunanen A, Fabiani E, Heier M, McMillan S, et al. The prevalence of celiac disease in Europe: results of a centralized, international mass screening project. Annals of medicine. 2010;42(8):587-95.
• 3. Saccone G, Berghella V, Sarno L, Maruotti GM, Cetin I, Greco L, et al. Celiac disease and obstetric complications: a systematic review and metaanalysis. Am J Obstet Gynecol. 2016;214(2):225-34.
• 4. Sheiner E, Peleg R, Levy A. Pregnancy outcome of patients with known celiac disease. European journal of obstetrics, gynecology, and reproductive biology. 2006;129(1):41-5.
• 5. Elliott B, Czuzoj-Shulman N, Spence AR, Mishkin DS, Abenhaim HA. Effect of celiac disease on maternal and neonatal outcomes of pregnancy. The Journal of Maternal-Fetal & Neonatal Medicine. 2021;34(13):2117-23.
• 6. Dhalwani NN, West J, Sultan AA, Ban L, Tata LJ. Women with celiac disease present with fertility problems no more often than women in the general population. Gastroenterology. 2014;147(6):1267-74.e1; quiz e13-4.
• 7. Tersigni C, Castellani R, de Waure C, Fattorossi A, De Spirito M, Gasbarrini A, et al. Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Human reproduction update. 2014;20(4):582-93.
• 8. Greco L, Veneziano A, Di Donato L, Zampella C, Pecoraro M, Paladini D, et al. Undiagnosed coeliac disease does not appear to be associated with unfavourable outcome of pregnancy. Gut. 2004;53(1):149-51.
• 9. Ludvigsson JF, Montgomery SM, Ekbom A. Celiac disease and risk of adverse fetal outcome: a population-based cohort study. Gastroenterology. 2005;129(2):454-63.
• 10. Pope R, Sheiner E. Celiac disease during pregnancy: to screen or not to screen? : Springer; 2009. p. 1-3.
• 11. Kuba K, Bernstein PS. ACOG practice bulletin no. 188: prelabor rupture of membranes. Obstetrics & Gynecology. 2018;131(6):1163-4.
• 12. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018;131(2):e49-e64.
• 13. Figueras F, Caradeux J, Crispi F, Eixarch E, Peguero A, Gratacos E. Diagnosis and surveillance of late-onset fetal growth restriction. Am J Obstet Gynecol. 2018;218(2s):S790-S802.e1.
• 14. ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2019;133(1):1.
• 15. Silver RM. Abnormal Placentation: Placenta Previa, Vasa Previa, and Placenta Accreta. Obstet Gynecol. 2015;126(3):654- 68.
• 16. Choi JM, Lebwohl B, Wang J, Lee SK, Murray JA, Sauer MV, et al. Increased prevalence of celiac disease in patients with unexplained infertility in the United States. J Reprod Med. 2011;56(5-6):199-203.
• 17. Kumar D. Prevalence of female infertility and its socio-economic factors in tribal communities of Central India. Rural and remote health. 2007;7(2):456.
• 18. Meloni GF, Dessole S, Vargiu N, Tomasi PA, Musumeci S. The prevalence of coeliac disease in infertility. Human reproduction (Oxford, England). 1999;14(11):2759-61.
• 19. Machado AP, Silva LR, Zausner B, Oliveira Jde A, Diniz DR, de Oliveira J. Undiagnosed celiac disease in women with infertility. J Reprod Med. 2013;58(1-2):61-6.
• 20. Boers K, Vlasveld T, van der Waart R. Pregnancy and coeliac disease. BMJ case reports. 2019;12(12).
• 21. Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum. Gastroenterology. 2001;120(3):636-51.
• 22. Tata LJ, Card TR, Logan RF, Hubbard RB, Smith CJ, West J. Fertility and pregnancy-related events in women with celiac disease: a population-based cohort study. Gastroenterology. 2005;128(4):849-55.
• 23. Myrsky E, Kaukinen K, Syrjänen M, Korponay-Szabó IR, Mäki M, Lindfors K. Coeliac disease-specific autoantibodies targeted against transglutaminase 2 disturb angiogenesis. Clinical and experimental immunology. 2008;152(1):111-9.
• 24. Anjum N, Baker PN, Robinson NJ, Aplin JD. Maternal celiac disease autoantibodies bind directly to syncytiotrophoblast and inhibit placental tissue transglutaminase activity. Reproductive biology and endocrinology : RB&E. 2009;7:16.
• 25. Sollid LM, Jabri B. Is celiac disease an autoimmune disorder? Current opinion in immunology. 2005;17(6):595-600.
• 26. Di Simone N, Silano M, Castellani R, Di Nicuolo F, D'Alessio MC, Franceschi F, et al. Anti-tissue transglutaminase antibodies from celiac patients are responsible for trophoblast damage via apoptosis in vitro. The American journal of gastroenterology. 2010;105(10):2254-61.